Thoughts on Detoxification, Treatment and Rehabilitation of Drug Addicts in Maldives

The problem of heroin addiction in Maldives is of undeniable concern for our entire community. We are fortunate that our leaders are thinking out of the matrix, on finding ways to deal with this issue and have probably initiated work that brings new hope for those struggling to cope with heroin addiction and the burdens associated with it.

I think, the idea of getting expertise from the international community, bringing them home to run a rehabilitation program in our country is definitely a better idea than sending big batches of addicts to rehab centres outside the country for long periods . In this way, we will have the opportunity to benefit from the time-tested methods of addiction management within our own socio-cultural milieau, and allow the opportunity for better community rehabilitation, especially facilitating the inclusion of family in the rehabilitation process.

Further, the idea of having a detoxification centre as announced by President Nasheed is again wonderful thinking. Definitely, detoxification is the first step involved in the treatment and rehabilitation for addiction and having the opportunity for detoxification in our country is an absolute must.

However, I was wondering whether we really need another 'centre' for detoxification?

In 2000-2001, a small unit for detoxification was built within DRC, Himmafushi. However, it is left for one to evaluate how well this unit was used to achieve its goal. If one reads the Auditor General's Report on NNCB, we do get to feel, that this centre and NNCB along with several components of its program are definitely worthy of further scrutiny.

Are we for example, using the available resources in terms of infrastructure to deliver proper services? Why don't we develop the centre which we already have to deliver additional services? If we do not have enough counsellors, psychologists, NA senior members, etc...can we not employ such technical people from the international community so that the recovering addicts can get proper and desired treatment (until we have trained enough people in the field) ?

I do believe, we need to detoxify each and every client who enter our treatment and rehabilitation program.... but my problem is this: do we need to invest in a new 'Detoxification Centre' in terms of infrastructure and do we have the manpower required for such a commitment?

Considering the limited resources we have and thinking of the existing facilities already available within the country, I was wondering why we may not go for options such as training groups of doctors or primary care physicians in the detoxification process instead and allow them to detoxify the clients in the general hospital setups in the country. Yet, I do understand, there may be some hazards associated with this, such as safety and security concerns of others admitted to the hospitals...but there are ways to overcome such hazards too.

Another option would be to send mobile teams of medical personnel along with deaddiction specialists to the island communities and to conduct detoxification camps. The team could conduct 1-2 week detoxification camps, start meetings and educate the community while based on these islands and then hand over the follow-up to those in the health centres. Those needing further care may be referred to other sources of help which may be available within each island, for example, there may be counsellors or people who could work as mentors, etc...

Many countries have special detoxification wards within the hospital set-ups. This is something that could perhaps be done in some of the regional hospitals in Maldives.

By allowing these people to be treated by the doctors in their island communities through detoxification in Regional hospitals and/or health centres, we will be providing the opportunity for rehabilitation within their own communities, while they are still with their parents , family members, religious scholars and peers. Thus, intergrating de-addiction management (at least the most basic and fundamental) within the existing health care system of the country.

Further, if the island communities can start small NA and NARANON meetings in the islands for those who undergo detoxification (with the help of NGO's who are already conducting such meetings in the country) this would be a golden opportunity for many to come out of this malice. NA members need encouragement and support from these island communities so that they can start and support these groups until they can run it by themselves.

Such a method of care may be especially useful for first timers . However, those who are unable to benefit from simple detoxification alone, or those with other comorbid problems or whose addiction severity demands further care and long term rehabilitation with the guidance of mental health and deaddiction experts, can be refered to the rehabilitation centres. Again, one could question whether those with history of offending and without such history need to be segregated....while they undergo such long term rehabilitation.

I have personally been involved with such detoxification camps in some of the South Asian countries and worked at some of the detoxification wards in general hospital setups and also in mental health set ups. I am aware that it is well received and has been found to be cost effective and reported to be useful.

These ofcourse are just some of my thoughts as I ponder on why we need to invest on another detoxification centre, while we have so many existing facilities that can be triggered with a single program to reach to every addict in the country, no matter which island they are living in. The emphasis of plucking these people away from the home island and bringing them to another Centre worries me.

What is required is additional training of primary health care professionals all over the country by a team of deaddiction professionals, dedicated only for this purpose who would take the responsibility of leading, monitoring, establishing minimum standards, facilitating and following up the program all over the country................!!!!....

Alternatively we may choose to just clap our hands as the ribbon for a new detoxification centre gets cut!

We Neglect Our Most Vulnerable; Such a Shame!

Those with mental illness and other mental challenges require the care of those who are blessed with better abilities.

But look at us....we have systematically failed to address the needs of the mentally ill.

According to the report in haveeru (http://www.haveeru.com.mv/?page=details&id=84570) a person with mental illness or mentally challenged person was found chained in a house at B. atoll Kamadhoo by some visiting students attending a program organised by eco-care and Soneva fushi resort.

Could it be possible that the people of this island were unaware of this fact? Could it be possible that the people of this island just could not care more? What is difficult for me is to accept that the concerned authorities in the island had no knowledge of what was going on in this home. Why?

That he began to cry on seeing these visitors for me echoes as an out cry for help and clearly demonstrate he had an insight into his circumstance.

Probably, this is a person who could have had a better quality of life if he was given an early intervention....may be he has special needs or may be he has a mental illness. However, the information so far reported is insufficient to draw any conclusions about his diagnosis.

It is very unfortunate that his parents were ignorant about the available facilities in the country which could have helped him have a better quality of life. It is very unfortunate that the people in the island did not report his case so that the existing NGO's in the country could have extended their helping hands to him. It is a shame, people are still unaware that people like him can have a better life with appropriate rehabilitation or treatment and keeping one in chains to manage is just unacceptable!

It is a shame, that we as a people are failing to address the issues relevant to the most vulnerable people of our country.

We have to move ahead from the times where we kept the mentally ill chained in 'andhagondi', or in 'dhandi koshi' built in our homes.

We have to reject the philosophy of those who say that the only way these people could be managed is by putting them in chain; we have to raise our voices to protect the rights of the mentally ill and the mentally challenged.

We have to make sure that our country soon develop a comprehensive mental health policy and plan. We have to ensure that we have mechanisms to prevent the repetition of such incidents in our legislature.

photo source ; Haveeru.com

Reporting of Child Abuse Issues; In Agreement with President Nasheed

I agree with what President Mohamed Nasheed said in today's rally against child abuse. His rationale for why there appears to be an increased incidence of abuse cases now appears to be relevant and true.

It is true child abuse has not suddenly escalated in the country, but decades of what has been pushed under the carpet has exploded ...only now. What we are seeing today is an aftermath...of many things gone wrong for a long long time.

May be for some reason people feel it is safe to report such incidents now, avenues for reporting have probably become more accessible now, may be the police is more vigilant and the authorities despite there being a risk for facing blame is willing to demonstrate greater transparency.

If one closely examine the reports of abuse which has hit our national headlines of recent and look at the time line, it becomes clear that most of the abuse that has been brought to the limelight began years ago.

We are fortunate that people can go out and rally about these issues today.

It is wonderful that our leaders kept aside their party interests and political differences for once, and spoke with national interest while pouring out their passion and commitment to bring out the changes which are so badly needed in our country.

I am sure those wonderful people, who for years have silently struggled to take care of victims of child abuse will now get due recogntion for their tireless work. I feel glad that today others have decided to take their burden to the national forefront and do something solid about addressing the issue of child abuse in the country.

For some reason I feel relieved today. I think I can see a rainbow in the sky.

The rally is hopefully going to be a beginning of real social reform and all those who joined their hands and hearts and brought their thoughts to their lips will carry forward good enough work in making our society a safer place.

Aameen.

A 5 Year Old Charged with Possession and Use of Narcotic Drugs !

This is really shocking news!

Reads Miadhu News 19th June 2009

"Maldives Police has arrested three people and a minor charged with possession and use of narcotic drugs. . The three people arrested are 5 year old Ibrahim Rafeeu of Manchangolhi Kuredhivaru, 28 year old Ali Mohamed Didi of Hudhuhudhaage / Gn Fuvahmulah and 25 year old Ismail Shifan of M. Opingsun...."

This boy is just 5 years old....and at this tender age he is being charged with possession and use of Narcotic drugs!!!

This is yet again another slap on the faces of all those who are trying to fight the increasing incidence of crime in our small society. Every day our media is reporting incidents of sexual abuse, paedophile....and all sorts of crime, especially crime against children.

Some how I see this child as a victim, a victim of drug abuse, a child abused at the hands of adults who introduced him to the world of crime and addiction by making him use and keep narcotic drugs with him.

When adults involve children / minors in the use and sale of drugs, we have to view it as child abuse. We cannot blame the child as much as we blame the adults who did this to the child. Where was his parents and/or gaurdians? This is a case which amounts to child abuse. I seriously believe that those who involve kids in crime have to be viewed as child abusers. Even the other children from that household is probably vulnerable and have to be offered all the necessary child protection services. The same risk factors which made this boy get abused is true for the siblings and need to be protected from being abused.

Unfortunately, for many of us child abuse only means sexual abuse or physical abuse, but we have to expand our understanding of that definition now. All those who abuse our kids either by introducing them to drugs and/or crime need to be charged for child abuse along with sentencing them for their other crimes. The two adults who were involved in this case need to be investigated on this ground as well.

Further, parents of such children have to be investigated. While it is indeed very sad to accept these terrible realities, I feel something has definitely gone very wrong with parenting these children , gone wrong within the family systems that it is apparent that the core of our society is rotting.

I hope this child gets justice.

I hope the arrest of this child will not give him a permanent admission to the school of crime and sentence him to a life of hopelessness.

I hope this arrest will not become another opening for his progress in the cycle of crime and violence.

This child need proper rehabilitation, ......let us ....stand up for this child and save his future and bring those who abused him , by introducing him to drugs and possession of drugs to face the court of justice.

This is why we cannot allow people who have been sentenced for drug offenses , to roam free on our streets. They are abusing our children.....and we must put a stop to this.

Criminal Profile of the Mother Who Abused and Murdered Her 8 Month Son with Lover

My questions and comments on observing this profile.

Was she put under any treatment or rehabilitation ?

Has she even been evaluated for underlying mental health problems? Does she have an underlying disability or is she suffering from a serious mental illness? If so, the whole profile need to be seen from a different perspective. Does she have a learning disability or does she suffer from a psychotic illness like schizophrenia? I seriously believe this has to be established in her case and those others who may be like her.

One news report said that she had a child before who is under state care. When there was such clear history why was this child put under an incompetent mother, who should have actually been in the prison.

When she has been sentenced for a particular period of imprisonment and it appears she ought to be serving that sentence, how come she is sentenced again for further crimes . Was she released from these sentences , if so why ????

So that she can go and offend again? Be caught again for more serious crime and given a harsher sentence? Whats the logic behind this?It is ridiculous to know she was living almost a free life even though she has been sentenced for a total of 30 years 8 months of imprisonment.

That too because so called competent people decided that she ought to be brought on parole so that she could breast feed the child( wonder about the rationale of breast feeding when mother is a chronic heroin addict!!!) . It is sad that competent people within the country could not be a part of this decision making process. Is there a possibility that the current political climate in the country has made some of the technical people or limited professionals redundant that they were not consulted ? If so this is very very sad!!

Furthermore, it appears that the voices and the decisions they had taken in the past did not apparently matter when she was granted parole or rather given a break from her prison sentence so she could give birth, breast feed have a lover and kill!!!!

All this reflects years of failure in providing justice to the people of this country.

Incompetent people with inadequate knowledge, in inappropriate positions of power, unable to network or unwilling to work as a team as key stakeholders... are just some of the problems that has failed the system which led to what we see in the criminal profile of this one woman alone.

Such a shame....! Let us hope things will change....in the times to come.

Several of my questions on 8 month baby murder case answered!!

I refer here to the article published on Minivan news today.

I am quoting some significant points which answers some of the questions I raised in my previous article.

Aminath Eenas told Minivan News today that one of the suspects, the baby’s mother, Nooruzaadha Ali, 28, from Addu atoll Hithadhoo;

'had been serving a sentence for drug abuse when she was given leave to give birth,.. she was a repeat offender, was eventually given parole.
The board decided she would continue her jail sentence a month after giving birth and the baby would be taken into care at the children’s home on Villingili'
But, said ' sentence was not enforced by DPRS'.

So she was a drug offender with a known history not under any rehabilitation or treatment programme, neglected or misjudged as safe to be out in the community by the parole board, although......!!!

Eenas added she was “socially, mentally and physically” unfit.
( But I have another question here..when she is mentally unfit...why was she not in Guraidhu receiving treatment? What was she doing in the prison...was she under psychiatric treatment? Did the parole board take the opinion of mental health professionals when they made decisions with regard to granting her parole? If not....fruit for thought again!! A call for improving national mental health services....even in prison caring for those with mental health problems in forensic units have to happen sooner than later..)

When such a clear understanding about her status was available then why an earth did the parole board grant this leave!! I personally know of women who had to give birth under the care of the state and who were even looked after by the state after the birth of the child... why was this woman treated otherwise , when there was a known risk!!!

DPRS Director General Mohamed Rasheed said Nooruzaadha was released for six months to breast feed and care for the baby.

NEGLECT BY WHOM??? WHO IS TO TAKE BLAME FOR THIS?

She like a 100 others are left to commit further crimes on innocent lives because the state could not afford to ensure that justice will prevail...due to...!

'At the end of the period, she was not returned to prison due to overcrowding'

VOICE OF JUSTIFICATION?

Why would any one take responsibility even there is gross neglect we know to point the finger at the others....

'Is it our fault the prison is overcrowded? Is it our fault there is no money to renovate? Or is it our fault that the crime rates are increasing?” he said.
Rasheed said many convicts were not imprisoned due to severe overcrowding in the country’s four jails.

BUT THOSE RESPONSIBLE MUST NOT ONLY TAKE THE BLAME BUT ALSO BE PUT TO TASK!

'Some blame the death of the baby on us,” he said.

We have to know that people who commit serious crime are sentenced to imprisonment because they are a threat to others and have committed offences and there is a chance they will re-offend if they are released like this. This is some thing even our kids ought to know.

“I would have prevented it if I knew what would happen in the future.”

RELEASE ALL THE CRIMINALS AND THINK NOTHING OF THIS SORT WILL HAPPEN IN THE FUTURE!!

Well, what we have in this report may have several information gaps and what we have heard so far is only one side of the coin.There are more questions which need to be answered. I sincerely hope they will be answered when the concerned authorities share the details of the case after thorough investigation. My call for those investigating the case is, do not limit your investigation to finding out how these people went about killing the child, but also investigate the state for neglect, for loop holes in the system due to which this killing was facilitated. Investigate the people in responsible positions who failed to protect this child.

Meanwhile, let us all unite in crying out for justice for this baby.

Let us hail the efforts well meaning people have initiated by submitting bills and petitions as a result of this babies death. And for goodness sake lets hope that political parties will not divide the people of this country anymore by using even this death as a tool to chuckle about.

Let us all begin to be more vigilant and active in getting justice for ourselves and those we love ...
I for one am calling upon the parole board to review their criteria for granting leave for women such as this mother. I am also calling all those released on parole and the man transfered from a 25 year prison sentence from Srilanka and now apparently brought to house arrest to be put back in prison.We cannot accept statement such as overcrowded prisons and allow criminals , people who have committed serious crime to roam free in the streets of our country. No, we cannot and must not allow this to happen!

We cannot turn blind for accidents that are waiting to happen...while we cry about this immense loss ..now we know for sure is related to much deeper issues.

Reference : Mohamed I,Ex-parole board member blames DPRS for death of baby; Minivan news;14 June 2009

Abuse And Murder Of a 8 Month Baby by a Heroin Addicted Couple in the Maldives

I want to step back, hold my emotions and wonder about this lady who with her lover or partner apparently throttled, sodomised and killed her own 8 month old son in Maldives, just yesterday.

The history so far reported , ring warning bells.
This mother was hooked to heroin, the little boys father is reportedly serving a sentence in prison for drug related offense and the lover has a past history for criminal offending.


Obviously, this woman must have given birth to the child with the knowledge of responsible people.
May be , just may be there would have been a sober adult in either side of the childs family who would have had some knowledge of the pathetic plight of these two people. Could they have prevented this tragedy?

May be the doctors who delivered this baby would have had some idea about the risks involved in allowing this woman to mother her child. Could they have prevented this tragedy?

Was there not a past history of drug dependence for this woman? Was she on any sort of rehabilitation programme?If Yes, why was she not monitored by anyone? Or were they already being monitored by the concerned authorities? Wonder why no one bothered to intervene before the baby died this terrible death. But then, who would have known? Who would have thought that humans could be so evil. We can suggest many things now, ofcourse in retrospect.

I can perfectly understand that we cannot afford to do risk assessment of every heroin addicted mother in the country. This would be an impossible task to take on. And I sincerely believe until this incident noone would have imagined the risks associated with substance dependence,violent offending and parenting.

However, I think this death is a wake up call for us.

It is time for us to add another problem to our list of social evils or woes. From gangs to paedophiles, it is time to begin worrying about handing over parental responsibilities to a large youth population addicted to heroin.

It is time to think about how many mothers or would be mothers are addicted to heroin, living in possibly abusive relationships and/or are victims who may not be able to defend themselves or those under their care.
Can they be identified? What can be done about them? Is the state ready to handle this problem. Let us sincerely hope we are not seing a tip of an iceberg here. Let us examine the cases of newborns , who have had problems due to maternal drug addiction..let us see the issues surrounding the babies who have so far been born to parents with serious drug problems.

It is time for proactive thinking so that we come out with new strategies so that mothers like this or lovers as sick as this will not be handed over the responsibility of caring for innocent lives.

While I have no sympathy for this woman, I wonder what was the mental status of this mother as this man , her alleged lover throttled and sodomised her 8 month old child.
Based on Western studies there is sufficient literature to suggest that substance abuse and violence is related, specially when there is a combination of mental illness and substance abuse , the risk for violence apparently increases.
But, we cannot apply such research findings in this case as this gruesome act was not carried out by a single person who may have had psychotic symptoms, but apparently with the participation of 2 other adults.


And any way who was the third person who was present when all this happened...who was he .. what was he doing and why is his identity being kept under secrecy while revealing all the details about the couple?
We must wait patiently now, like we have been for every case like this ..until the concerned authorities investigate and punish those involved in the crime.

But, what ever that will follow, this innocent childs right for a life have been snatched from him.
Now, as this baby lies in his grave, it is for the rest of us to decide whether we will forget his death and go about our life with the attitude, ' what can I do about it any way' or take this seriously enough to have a look around whats going on within our own families, amongst our own friends and neighbours , amongst those whom we care for and intervene and prevent the repetition of crimes like this.

Report if you feel something may be seriously wrong in a family and that children are being abused or neglected. Report if you see violence against children. Report neglect.

Report abuse. Talk to families who are hiding violence and abuse of children in the name of family honour. They is no family honour if a mother is hiding the fact that her son is abusing her own daughter. Inform such parents that by not reporting such things, the mother is encouraging her child to move to greater crimes and is encouraging and supporting crime.

Sentencing this woman and man would not be enough.

We have to identify, understand, analyse the underlying causes which led this to happen and then develop strategies that can be implemented so that our babies can have a right to life, even if they are born to irresponsible parents like these.

There is a lesson in this for all of us.

Let us become better parents. Let us become better family members, let us become better friends, let us become better neighbours, let us become better citizens. Let us see what each one of us could do at an individual level to make a difference.
Let us also not forget to question the state about what has happened in the case of this death and what they plan to do to ensure that some thing like this does not happen again.

Lack of halfway house main cause for the high relapse rate - HRCM???

Can one prove this statement to be true?
http://www.miadhu.com.mv/news.php?id=10329

May be lack of a half way house is one contributing factor, but it is premature to assume this to be the main cause for relapse!

Can the HRCM then state the type of rehabilitation program offered at DRC is useful and state that having the half way house will make all the difference?

I think before making statements like this, it is better to have appropriate research conducted by professionals in the field!!!.

NNCB already have many facilities, perhaps it is high time some one researched on what is going on at these places where so much of government finances are already being exhausted.

I am yet to come across 'lack of a half way house' as a cause of relapse....to state this is the main cause of the high relapse rate is just ridiculous.

I also wonder whether it is really upto HRCM to identify the causes of relapse of the drug dependent people of the Maldives ?

Should they also start providing inputs on the quality and type of treatment and rehabilitation programmes that are required?

Or should they be investigating the abuse of rights of the clients that may or may not be happening within the rehabilitation system of Maldives instead?

Wonder whether it would be of any use if someone examined whether such abuse of rights happen at admission and discharge of the clients from these programmes, when addicts who are users get criminalised ..etc..should not the commission be looking at things like this instead of examining the causes of relapse and making statements of this nature!!

But if not HRCM, who else would become the watchdog for those involved in the rehabilitation process? We do need reports like the auditor generals , to get insights into whats really going on within the walls of these institutes.

We also need professionals ( national or international) to come and evaluate these programs so that they can make recommendations to aspects like effectiveness of treatment, rehabilitation and prevention models that are followed in the country.

Policy makers need to look for research based evidence when they make decisions on how to proceed on delivering cost effective programmes to address the drug problem of the country. And if HRCM or any other body need to make a comment on such technical aspects perhaps it would be better to refer to such reports!

Auditor Generals Report on NNCB, Maldives

Thank you, Auditor General.

All I can say at the moment is a THANKYOU for having the courage to expose these truths.

Please read the report on Minivan news http://www.minivannews.com/news_detail.php?id=6637